Vital Cells (in brain, heart, muscles, organs) demand nutrition, oxygen, energy (glucose) at a constant supply. These components are found in the blood which runs in a healthy vascular system. As a pump system, the heart ensures the circulation of the blood (nutrients) through the body. When there is a discrepancy between demand of oxygen or nutrients to the cell and the delivery capacity of the bloodstream to the cell, there is cell damage or even cell death. In some vital organs this warm ischemia before cell death is very short. For brain cells, death occurs after 3 minutes. The reason for this insufficiency is mostly a vascular disease (arteriosclerosis), stenosis, occlusion of small or large vessels, or a heart problem (coronary disease). Most important risk factors of arteriosclerosis are: hypertension, elevated serum lipids, cigarette smoking, diabetes mellitus, decreased physical activity and obesitas (i.e., consuming more calories than those expended as energy).
Treatment Options
To treat a clogged or occluded blood vessel, PHARMACOTHERAPY and SURGERY have been practiced. Pharmacotherapy is useful for treatment at the initial stage but not when there is further progression of the disease, leading to occlusion of the vessel and eventually to an infarct (of the heart, brain, kidney. etc).
The medical diagnostic tools and the technical developments available to the doctor have increased enormously, MRI-, MRA-, CT- and CTA-scan. This has enabled an early diagnosis and a more successful treatment of patients with vascular diseases.
In vascular surgery we have, firstly, the endovascular procedures, for example: stents, which can expand the occluded vessel in heart surgery (coronary artery) and in vascular surgery (stenosis of the carotic artery); stents remodelling aneurysma of the aorta abdominals; and recently the brain stents remodelling fusiform aneurysma of the basilar artery.
In vascular surgery we have, secondly, the revascularisation operations, viz. anastomosis and bypass operations. These revascularisation operations are carried out when there is (risk of) ischaemia, (risk of) infarct (of the heart, brain, limb, etc). Bypass procedures in general vascular surgery, in heart surgery (coronary bypass), and in neurosurgery want to bypass huge vascular malformations (giant aneurysmas). In tumor surgery, bypass operations want to avoid the risk of brain-infarct after and/or before removing the tumor.
The graft can be an arterial graft (in the case of heart surgery it would be the lima, or rima; in the case of neurosurgery, it would be the temporal artery or the occipital artery), or a venous graft (v.s.m), or even prosthetic material. These highly complex operations require a competent surgical team, delicate instruments, advanced microsurgical equipment, magnifying loops, or—for neurosurgeons—an operating microscope.
In microvascular surgery, ultra fine suture material is used to suture the blood vessels onto each other (anastomosis). This technique of suturing is time consuming and it demands extremely advanced microsurgical skills. Moreover, it never results in a completely smooth joint, the stitches producing microscopic creases in the vessel wall. Various methods have been developed to perform anastomosis with mechanical devices in a short time without suturing. Most of these devices are complex and time-consuming to apply (for example, in brain-surgery, a microvascular anastomosis takes on average, twenty to thirty minutes).
During this time, there is a high risk of bleeding and infection in all forms of microvascular surgery mentioned above. Reducing this time is of the utmost importance for the well-being of the patient.